when a male patient pulls foley out..

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What would be an appropriate nursing intervention when a male patient pulls foley out with balloon still inflated and bleeding from the site? Do you insert another foley or just leave it until bleeding stops? what else can be done?

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Specializes in Med/Surg, Ortho, ASC.

You report the incident and do as the urologist/managing MD prescribes.

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Put another foley in quick or you may not be able to due to swelling of the uretha.

PS there will be a lot of blood when they do this, it's pretty scary the first time you see it. Expect blood in the urine for a time, not huge clots but visible pink to red color gradually decreasing in color and amount.

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Specializes in Trauma/Tele/Surgery/SICU.

I have had this happen on a few occasions and in each case the urologist requested the foley be replaced immediately. When a pt. pulls the inflated balloon out there will be tissue trauma and swelling which can result in the inability of urine to pass which can lead to arf, bladder rupture etc. Also with bleeding there is the potential for clots to form and if you have a foley you can irrigate if necessary to keep the bladder and uretha free from clots and blockages.

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A suggestion- whenever you have a patient w/a foley, get the order to replace it prn unscheduled removal....then if it's 3 a.m. and the guy is confused, there isn't the hassle of calling then for an order to replace it. JME. :)

Also- another topic- if you have skin tear treatments, technically they have to continue unless the order says "until healed". You can get dinged for not doing treatments :)

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Specializes in Trauma Surgery, Nursing Management.

Urology consult. Stat!

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Specializes in Critical Care, Capacity/Bed Management.
A suggestion- whenever you have a patient w/a foley, get the order to replace it prn unscheduled removal....then if it's 3 a.m. and the guy is confused, there isn't the hassle of calling then for an order to replace it. JME. :)

Also- another topic- if you have skin tear treatments, technically they have to continue unless the order says "until healed". You can get dinged for not doing treatments :)

Hate to hijack the thread but at my facility skin tears are treated with Nu-Gel and TEGADERM! I do not understand the reasoning behind tegaderm since the skin is already fragile and compromised adding it would cause more tears when taking it off..... sorry had to vent

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Hate to hijack the thread but at my facility skin tears are treated with Nu-Gel and TEGADERM! I do not understand the reasoning behind tegaderm since the skin is already fragile and compromised adding it would cause more tears when taking it off..... sorry had to vent

We used a really thin colloidal that had easy-off (don't remember the brand) adhesive OR steri-strips (after a sterile cotton swab realignment of the skin) w/vaseline gauze and roll gauze.

I wouldn't like Tegaderm on older folks papery skin either...:twocents:

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Specializes in TCU, LTC/Rehab.

I wasn't a nurse yet, but believe it or not, we once had a confused male pt managed to deflate the balloon first and pull his foley out.

He didn't know what was going on, but I thought it was smart of him... :yeah:

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I wasn't a nurse yet, but believe it or not, we once had a confused male pt deflate the balloon and pull his foley out.

He didn't know what was going on, but I thought it was smart of him... :yeah:

How did he get a syringe??:)

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Specializes in TCU, LTC/Rehab.
How did he get a syringe??:)

The nurses figured out how he managed to do it...

I only worked every other weekend and my job was to do the meds (we call it here medication aides) so I just used to mind my own business passing all the meds.

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Who needs a syringe? I've seen pts chew on the tube.

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